Novel Treatment Approaches in Hodgkin Lymphoma

Panelists: Jonathan W. Friedberg, MD, University of Rochester; Paul A. Hamlin, MD, MSKCC;
Craig H. Moskowitz, MD, MSKCC; Lauren C. Pinter-Brown, MD, UCLA;
Peter L. Salgo, MD, Columbia University
Published Online: Friday, July 19, 2013
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Clinical trials are currently exploring the application and frontline utilization of novel therapeutic approaches for the treatment of patients with Hodgkin lymphoma.

Targeting CD30 with the antibody drug conjugate brentuximab vedotin has greatly impacted the systemic treatment of Hodgkin lymphoma, believes Jonathan W. Friedberg, MD. This approach results in a response rate of nearly 80% with some durable remissions, in the salvage setting. This high-level of activity will likely alter the role of allogeneic transplantation in this setting, believes Friedberg. In addition to this initial indication, trials are exploring brentuximab vedotin in earlier lines of treatment, explains Friedberg. In a phase III trial, the standard regimen of ABVD (adriamycin, bleomycin, vinblastine, and dacarbazine) is being compared to AVD plus brentuximab vedotin as a frontline treatment.
 
The HDAC inhibitor panobinostat was investigated at the same time as brentuximab vedotin, explains Craig H. Moskowitz, MD. In these separate studies, complete and overall response rate was shown to be much higher with brentuximab vedotin, leading to its FDA approval. However, Moskowitz adds, despite being less efficacious in these parallel trials, there still could be a role for HDAC inhibitors in Hodgkin lymphoma.
 
Agents that target the PI3K/AKT/mTOR pathway have shown promise in the treatment of patients with relapsed and refractory Hodgkin lymphoma, explains Lauren C. Pinter-Brown, MD. For instance, she notes, the mTOR inhibitor everolimus elicited a 40% response rate with prolonged disease control following autologous transplantation. Additionally, the safety and efficacy of the agent idelalisib (GS-1101), a PI3K delta inhibitor, is being explored in phase II trials.
 
Bendamustine and lenalidomide have shown promise in other hematologic malignancies, warranting their research in Hodgkin lymphoma, notes Paul A. Hamlin, MD. At this point, bendamustine has been explored as a treatment for patients who do not respond to salvage therapy. Unfortunately, this agent did not demonstrate a high-duration of disease control, Hamlin notes. Additionally, the immunomodulatory agent lenalidomide demonstrated activity in the last-line setting, Hamlin notes. However, further research is still needed to cull out which patients benefited the most.
 
While many of these novel agents are showing promising activity, it remains unclear where they will fit in the sequence, since 90% to 95% of patients with Hodgkin lymphoma are cured by ABVD, Friedberg adds. These agents will likely be incorporated into the treatment regimens of high-risk patients first, Friedberg believes. However, he adds, they may not ever make their way into standard regimens.
View More From This Discussion
Episode 1 Risk-Adapted Approaches in Hodgkin Lymphoma
Episode 2 Optimizing Radiation Therapy in Hodgkin Lymphoma
Episode 3 Reducing Therapy-Related Toxicity in Hodgkin Lymphoma
Episode 4 Management of Hodgkin Lymphoma in Elderly Patients
Episode 5 Primary Management of Advanced Hodgkin Lymphoma
Episode 6 The Role of PET Imaging in Hodgkin Lymphoma
Episode 7 Treating Relapsed and Refractory Hodgkin Lymphoma
Episode 8 Autologous Transplantation in Hodgkin Lymphoma
Episode 9 Utilization of Brentuximab Vedotin in Hodgkin Lymphoma
Episode 10 Allogeneic Transplantation in Hodgkin Lymphoma
Episode 11 Novel Treatment Approaches in Hodgkin Lymphoma
Episode 12 Conclusion: Final Thoughts on Managing Hodgkin Lymphoma
Expert Panelists

Jonathan W. Friedberg, MD

Director, James P. Wilmot Cancer Center
Chief, Hematology/Oncology
Director, Hematological Malignancies Clinical Research, University of Rochester
Rochester, New York

Paul A. Hamlin, MD

Director, Lymphoma Outpatient Activities,
Division of Hematology/Oncology
Memorial Sloan Kettering Cancer Center
New York, New York
 

Craig H. Moskowitz, MD

Clinical Director, Division of Hematologic Oncology, Attending Physician, Lymphoma and Adult BMT Services, Memorial Sloan Kettering Cancer Center, New York, New York

Lauren C. Pinter-Brown, MD

Clinical Professor of Medicine
The Geffen School of Medicine,
University of California, Los Angeles
Los Angeles, California
 

Peter L. Salgo, MD

Moderator
Professor of Medicine and Anesthesiology, Columbia University;
Associate Director of Surgical Intensive Care, New York Presbyterian Hospital
New York, New York
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